Topical minoxidil (marketed as Rogaine) is the traditional way of delivering minoxidil to the scalp. However, what has gained traction over the past few years is using oral minoxidil, which is actually how minoxidil was discovered since higher oral doses are still used for high blood pressure and hair growth was noticed in these patients on this treatment. Oral minoxidil offers a much easier compliant route of delivery for patients and can be compounded as a single pill with oral finasteride to further make taking a single pill easier. Typically, it is just once a day that you would take this pill.
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What to Do:
- Oral minoxidil is given as a single pill once daily with usually 2.5 mg for women and 5 mg dose for men as a starting dose but can be easily dosed lower if side effects occur.
- The Hair Genome Test provides a way to determine exactly what dose would be appropriate for you based on your genetic profile.
What to Expect:
- Oral minoxidil has a slightly higher side effect risk compared with topical minoxidil that includes lower blood pressure, swelling in the legs, dizziness/headaches, allergic reaction, and heart palpitations (feeling the heart beating fast), and facial hair growth for women, but the incidence is very low with a recent study seeing many of these side effects occurring in 2 in 1,000 individuals.
- Effectiveness of the medication may be higher than topical minoxidil in some individuals since 30-50% of patients have a reduced level of an enzyme known as sulfotransferase in the scalp that is required to convert minoxidil into its active metabolite minoxidil sulfate. The oral route bypasses the need for scalp conversion of minoxidil. These genetic limitations can be determined via the Hair Genome Test
Do I need a prescription for oral minoxidil?Yes, any oral minoxidil requires a prescription from Dr. Lam to take.
How should I decide between topical and oral minoxidil?This decision should be made with Dr. Lam in consultation. Topical minoxidil has a lower risk of side effects mentioned above but a higher risk of a topical allergy like redness and itchiness on the scalp. Some formulations of topical minoxidil also may leave the scalp greasy or weighed down. Topical formulations can be combined with topical finasteride as a single product. The oral route has the benefit of easier compliance since it is easier to take a single pill once a day than to apply it onto the scalp. Also, the oral dose may work better in some individuals, especially if the Hair Genome Test is not performed to more accurately determine the effectiveness and dosing of the topical formulation.
If I take minoxidil do I need to take finasteride?For women of child-bearing age, finasteride may not be a safe option. However, in post-menopausal women, finasteride may be combined with minoxidil. Men will usually benefit from taking both medications. In general, the two medications are synergistic in that the two together work better than a single medication alone. If you take the Hair Genome Test, you may find that you are more resistant to minoxidil or finasteride, and Dr. Lam and his staff may counsel you on the more effective of the two medications if you can only take one.
Are there any conditions that would preclude me from taking oral minoxidil?In general, if you have significant cardiac (heart) issues, it may be safer to avoid oral minoxidil and use the topical version. As mentioned, if you are experiencing any adverse symptoms that are not resolved with reducing the oral dose, then you may need to convert to using a topical formulation.
I am a woman. I am worried about hair growth on my face. What should I know?In general, the incidence of facial hair growth is quite low of around 5% but slightly higher with an oral dose. In the few women who get facial hair growth, they actually notice the most remarkable hair growth on their scalp and some elect to continue with the therapy despite the unwanted hair growth elsewhere.